What happens if we downsized (e.g. sold the car) during the 5-year look back period?

Try to clearly find out IF Medicaid in your state will pay for AL. Alot of states medicaid DO NOT cover AL at all. Those states that do have it done by a waiver program so it tends to be a limited # of waivers allowed at any time. Also ask every AL clearly if the AL takes Medicaid, most do not. And ask IF there is a waiting list OR is it the situation that the AL expects them to private pay for a period of time (usually 2 years) before they can get one of the medicaid waiver spots. 2 years private pay seems to be standard. It could be very challenging to get two AL waivers simultaneously.

It may be actually easier if they have more serious health issues to get them into a NH. NH medicaid is dedicated funding and theres lots more beds. It's something to speak with their MD about to see if their current health history shows the need for skilled nursing care (that means they need a NH) and if their MD will write orders for skilled nursing care needed.

About the caregiver exemption, it will require documentation to support the exemption. If you still work full time at another job, you may not be considered eligible for caregiver exemption. Really others are spot-on that your folks need to speak with an elder law atty to see what issues may be there if they did stuff as a DIY.

Everything would have had to be sold at fair market value. They cannot gift their car to you. You should have paid market value. Furnishings, etc, not sure what Medicaid would do with that. Did they own a house? That would have to be sold at fair market value, as well. What was not sold at market value will become a dollar for dollar penalty when your folks will not qualify for Medicaid. Someone else will either need to provide free care or the money will need to be repaid. See an elder law attorney that specializes in Medicaid.

Just read that property was transferred to you when you started providing care for your folks. How long did you care for them. Some states, the home is exempt from Medicaid penalty if transferred to a caregiver child if, IF they provided necessary medical care for a period of two years prior to entering a nursing home. Not assisted living.

You need to see an elder law attorney. The house cannot be transferred until after two years of care.

Unless your parents owned valuable antiques, I wouldn't worry about the furniture. The car might be a little different because that will appear as a gift. On the other hand, they gave it to you with the expectation that they would get something in return -- transportation when they needed it.

I agree that consulting an attorney specializing in Elder Law would be a good thing at this point. Use your parents' money for this -- it is on their behalf.